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Choedon T, Brennan E, Joe W, Lelijveld N, Huse O, Zorbas C, Backholer K, Murira Z, Wrottesley SV, Sethi V. Nutritional status of school-age children (5-19 years) in South Asia: A scoping review. MATERNAL & CHILD NUTRITION 2024; 20:e13607. [PMID: 38095279 PMCID: PMC10981491 DOI: 10.1111/mcn.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 04/01/2024]
Abstract
Information on malnutrition for school-age children and adolescents (5-19 years) in South Asia is fragmented and inconsistent, which limits the prioritization of nutrition policies, programmes and research for this age group. This scoping review aimed to synthesize existing evidence on the burden of malnutrition for children and adolescents aged 5-19 years in South Asia, and on interventions to improve their nutritional status. Cochrane Library, EMBASE, Medline and Google Scholar were systematically searched for articles published between January 2016 and November 2022. Eligible studies reported the prevalence of undernutrition, overweight/obesity, micronutrient deficiencies and unhealthy dietary intakes, and interventions that aimed to address these in South Asia. In total, 296 articles met our inclusion criteria. Evidence revealed widespread, yet heterogeneous, prevalence of undernutrition among South Asian children and adolescents: thinness (1.9%-88.8%), wasting (3%-48%), underweight (9.5%-84.4%) and stunting (3.7%-71.7%). A triple burden of malnutrition was evident: the prevalence of overweight and obesity ranged from 0.2% to 73% and 0% to 38% (with rapidly rising trends), respectively, alongside persistent micronutrient deficiencies. Diets often failed to meet nutritional requirements and high levels of fast-food consumption were reported. Education, fortification, supplementation and school feeding programmes demonstrated beneficial effects on nutritional status. Comprehensive and regular monitoring of all forms of malnutrition among children and adolescents, across all countries in South Asia is required. Further, more large-scale intervention research is needed to ensure policy and programmes effectively target and address malnutrition among children and adolescents in South Asia.
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Affiliation(s)
| | | | - William Joe
- Institute of Economic Growth (IEG)DelhiIndia
| | | | - Oliver Huse
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Christina Zorbas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | | | | | - Vani Sethi
- UNICEF South Asia Regional OfficeKathmanduNepal
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Noor M, Kiran A, Shahbaz M, Sanaullah M, Wakeel A. Root system architecture associated zinc variability in wheat (Triticum aestivum L.). Sci Rep 2024; 14:1781. [PMID: 38245570 PMCID: PMC10799890 DOI: 10.1038/s41598-024-52338-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
Root system architecture (RSA) plays a fundamental role in nutrient uptake, including zinc (Zn). Wheat grains are inheritably low in Zn. As Zn is an essential nutrient for plants, improving its uptake will not only improve their growth and yield but also the nutritional quality of staple grains. A rhizobox study followed by a pot study was conducted to evaluate Zn variability with respect to RSA and its impact on grain Zn concentration. The grain Zn content of one hundred wheat varieties was determined and grown in rhizoboxes with differential Zn (no Zn and 0.05 mg L-1 ZnSO4). Seedlings were harvested 12 days after sowing, and root images were taken and analyzed by SmartRoot software. Using principal component analysis, twelve varieties were screened out based on vigorous and weaker RSA with high and low grain Zn content. The screened varieties were grown in pots with (11 mg ZnSO4 kg-1 soil) and without Zn application to the soil. Zinc translocation, localization, and agronomic parameters were recorded after harvesting at maturity. In the rhizobox experiment, 4% and 8% varieties showed higher grain Zn content with vigorous and weaker RSA, respectively, while 45% and 43% varieties had lower grain Zn content with vigorous and weaker RSA. However, the pot experiment revealed that varieties with vigorous root system led to higher grain yield, though the grain Zn concentration were variable, while all varieties with weaker root system had lower yield as well as grain Zn concentration. Zincol-16 revealed the highest Zn concentration (28.07 mg kg-1) and grain weight (47.9 g). Comparatively higher level of Zn was localized in the aleurone layer than in the embryonic region and endosperm. It is concluded that genetic variability exists among wheat varieties for RSA and grain Zn content, with a significant correlation. Therefore, RSA attributes are promising targets for the Zn biofortification breeding program. However, Zn localization in endosperm needs to be further investigated to achieve the goal of reducing Zn malnutrition.
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Affiliation(s)
- Mehwish Noor
- Department of Botany, University of Agriculture, Faisalabad, 38040, Pakistan
| | - Aysha Kiran
- Department of Botany, University of Agriculture, Faisalabad, 38040, Pakistan.
| | - Muhammad Shahbaz
- Department of Botany, University of Agriculture, Faisalabad, 38040, Pakistan
| | - Muhammad Sanaullah
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, 38040, Pakistan
| | - Abdul Wakeel
- Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, 38040, Pakistan.
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Abayomi J, Charnley M, Stone G, Lane K, Stevenson L, Davies I, Webb R. Editorial: nutrition at key stages of the lifecycle. Proc Nutr Soc 2024:1-7. [PMID: 38240093 DOI: 10.1017/s0029665124000089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Nutritional requirements of individuals vary across the lifecycle, according to activity, age and gender. To optimize human health, consideration of nutritional priorities at each stage is needed. This conference brought together multidisciplinary experts in maternal and child nutrition and health, cardiometabolic and plant-based nutrition and dietitians involved in the care of vulnerable populations, plus nutritional metabolism, health and ageing. The presentations highlighted the most important nutrition research in these areas, updating knowledge and suggesting how dietary advice and policy could be adapted to incorporate research findings. With the global increase in non-communicable disease (NCD) and nutrition being considered as a key modifiable risk factor for the prevention and management of NCD, this conference was much needed.
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Affiliation(s)
- Julie Abayomi
- School of Medicine & Nutrition, Faculty of Health, Social Care and Medicine, Edge Hill University, OrmskirkL39 4PQ, UK
| | - Margaret Charnley
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - Genevieve Stone
- School of Medicine & Nutrition, Faculty of Health, Social Care and Medicine, Edge Hill University, OrmskirkL39 4PQ, UK
| | - Katie Lane
- Research Institute for Sport and Exercise Sciences (RISES), Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Leo Stevenson
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool, UK
| | - Ian Davies
- Research Institute for Sport and Exercise Sciences (RISES), Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Richard Webb
- School of Health & Sport Sciences, Liverpool Hope University, Liverpool, UK
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Lowe NM. Fortification or biofortification: complimentary strategies or duplication of effort? Proc Nutr Soc 2024:1-10. [PMID: 38197143 DOI: 10.1017/s0029665124000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Micronutrient deficiencies continue to be a global concern, with the most common deficiencies being vitamin A, iron, zinc and B vitamins (folate and B12). Addressing this requires strategies that are scalable and equitable such that they reach all members of a population irrespective of socioeconomic status and geography. Fortification and biofortification offer potential large-scale solutions, however each have strengths and limitations depending on the context, particularly the cultural and political factors that may create barriers or opportunities for effectiveness. Planning how to target scarce resources for maximum impact requires an in-depth knowledge and understanding of local food systems and market dynamics, alongside strong government policy and legislative support. A food fortification programme was launched in Pakistan in 2016, supported by UK Aid and designed to address the high prevalence of vitamin A, iron and zinc deficiency, particularly in women and children. In the same year, the first zinc biofortified variety of wheat, Zincol-2016, was released in Pakistan, supported and developed through the HarvestPlus programme in collaboration with the Pakistan National Agriculture Research Centre. This review explores the challenges faced by fortification and biofortification, initiated independently, (but around the same time) in Pakistan.
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Affiliation(s)
- Nicola Mary Lowe
- Centre for Global Development, University of Central Lancashire, PrestonPR1 2HE, UK
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Ceballos-Rasgado M, Ajmal S, Mahboob U, Ander EL, Zia M, Moran VH, Joy EJM, Zaman M, Ohly H, Lowe NM. Farmers' and millers' experiences and attitudes towards the production and processing of zinc biofortified wheat in Pakistan: a mixed methods study. Front Nutr 2023; 10:1158156. [PMID: 37941768 PMCID: PMC10629276 DOI: 10.3389/fnut.2023.1158156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023] Open
Abstract
Background Zinc biofortified wheat may be a sustainable strategy to increase zinc intake in areas where fortification and dietary diversification are not feasible or are limited by household purchasing power. This convergent mixed methods study aimed to explore the farmers' and millers' experiences and attitudes towards the production and processing of zinc biofortified wheat in Pakistan. Methods A telephone survey was conducted with farmers (n = 418) who were provided with Zincol-2016 biofortified wheat seed for the 2019-2020 growing season, as part of a wheat grain micronutrient mapping study across Punjab Province. The survey explored the farmers' experiences of growing Zincol-2016 and whether they opted to grow it again in the subsequent season. Semi-structured focus group discussions were undertaken in a separate group of farmers in Khyber Pakhtunkhwa (KP) province (n = 12) who grew Zincol-2016 for the BiZiFED2 RCT. Millers were also interviewed in KP, both those who had processed Zincol-2016 for the trial (n = 12) and those who had no experience of processing biofortified wheat (n = 12). Survey data were analyzed using descriptive statistics and transcripts of focus groups were analyzed using thematic analysis. Results Nearly half of farmers who responded to the survey (47%) re-cultivated Zincol-2016 in the following season. The drivers for Zincol-2016 re-cultivation were seed availability (100%), grain yield and growth resistance (98%), quality of the flour from the previous harvest (97%) and nutritional benefit (94.5%). Discussions with farmers suggested that the main motivators for potential scale-up of biofortified wheat were the perceived quality of the grain, wheat, and flour. Millers saw it as an opportunity to expand their business. Farmers and millers valued the health benefits of the wheat. Challenges for scale-up include the need of additional support to produce it, unfamiliarity with the biofortification process, production costs, and external threats to the supply chain. Conclusion Farmers and millers showed a strong implicit preference for Zincol-2016 over alternative varieties. Crop performance and product yield were the most cited motivators for growing Zincol-2016. Farmers and millers are willing to produce and process biofortified wheat if financial and educational support is provided.
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Affiliation(s)
| | | | - Usman Mahboob
- Institute of Health Professions Education and Research, Khyber Medical University, Peshawar, Pakistan
| | - E. Louise Ander
- Inorganic Geochemistry, Centre for Environmental Geochemistry, British Geological Survey, Nottingham, United Kingdom
| | - Munir Zia
- Research & Development Department, Fauji Fertilizer Company Ltd, Rawalpindi, Pakistan
| | - Victoria Hall Moran
- Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
| | - Edward J. M. Joy
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mukhtiar Zaman
- Department of Pulmonology, Rehman Medical Institute, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Heather Ohly
- Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
| | - Nicola M. Lowe
- Centre for Global Development, University of Central Lancashire, Preston, United Kingdom
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Signorell C, Kurpad AV, Pauline M, Shenvi S, Mukhopadhyay A, King JC, Zimmermann MB, Moretti D. The Effect of Zinc Biofortified Wheat Produced via Foliar Application on Zinc Status: A Randomized, Controlled Trial in Indian Children. J Nutr 2023; 153:3092-3100. [PMID: 37633331 DOI: 10.1016/j.tjnut.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Agronomic zinc biofortification of wheat by foliar application increases wheat zinc content and total zinc absorption in humans. OBJECTIVES To assess the effect of agronomically biofortified whole wheat flour (BFW) on plasma zinc (PZC) compared with a postharvest fortified wheat (PHFW) and unfortified control wheat (CW) when integrated in a midday school meal scheme. METHODS We conducted a 20-wk double-blind intervention trial in children (4-12 y, n = 273) individually randomly assigned to 3 groups to receive a daily school lunch consisting of 3 chapattis prepared with the 3 different wheat flour types. Measurements of anthropometry, blood biochemistry, and leukocyte DNA strand breaks were conducted. We applied sparse serial sampling to monitor PZC over time, and analysis was performed using linear mixed-effects models. RESULTS Mean zinc content in BFW, PHFW, and CW were 48.0, 45.1, and 21.2 ppm, respectively (P < 0.001). Mean (standard deviation) daily zinc intakes in the study intervention in BFW, PHFW, and CW groups were 4.4 (1.6), 5.9 (1.9) and 2.6 (0.6) mg Zn/d, respectively, with intake in groups PHFW and BFW differing from CW (P < 0.001) but no difference between BFW and PHFW. There were no time effect, group difference, or group × time interaction in PZC. Prevalence of zinc deficiency decreased in the BFW (from 14.1%-11.2%), PHFW (from 8.9%-2.3%), and CW (9.8%-8.8%) groups, but there was no time × treatment interaction in the prevalence of zinc deficiency (P = 0.191). Compliance with consuming the study school meals was associated with PZC (P = 0.006). DNA strand breaks were not significantly associated with PZC (n = 51; r = 0.004, P = 0.945). CONCLUSIONS Consumption of either PHFW or BFW provided an additional ∼1.8 to 3.3 mg Zn/d, but it did not affect PZC or zinc deficiency, growth, or DNA strand breaks. This trial was registered on clinicaltrials.gov as NCT02241330 and ctri.nic.in as CTRI/2015/06/005913.
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Affiliation(s)
- Coralie Signorell
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Anura V Kurpad
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Maria Pauline
- Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bengaluru, India
| | - Swapna Shenvi
- Nutrition and Metabolism Center, Children's Hospital Oakland Research Institute, Oakland, CA, United States
| | | | - Janet C King
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, CA, United States
| | - Michael B Zimmermann
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland
| | - Diego Moretti
- Laboratory for Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; Nutrition Group, Swiss Distance Learning University of Applied Sciences (FFHS)/University of Applied Sciences of South Switzerland (SUPSI), Zürich, Switzerland.
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Frederickson CJ, Fleming DEB, Asael D, Zaman M, Ferguson R, Kaiser MG, Rankin BD, Schenkels KMM, Hess AIT, Scott AR, Frederickson CJM, Sinclair JK, Lowe NM. Single hair analysis by X-ray fluorescence spectrometry detects small changes in dietary zinc intake: A nested randomized controlled trial. Front Nutr 2023; 10:1139017. [PMID: 37032778 PMCID: PMC10080032 DOI: 10.3389/fnut.2023.1139017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
The aim of this study was to determine whether X-ray fluorescence spectrometry (XRF) could be used to detect changes in hair zinc concentration in response to a modest daily increase in zinc from the consumption of zinc biofortified wheat flour. This study was conducted as part of an effectiveness trial (BiZiFED2) exploring the potential for zinc biofortified wheat to alleviate zinc deficiency in adolescent girls aged 10-16 years in Pakistan (trial registration ID ISRCTN17107812). A randomized controlled design was used. Participants received either control flour or zinc biofortified flour for 6 months. Consumption of biofortified flour resulted in an average daily increase in dietary zinc intake of 1.5 mg per day above that of the control flour. At baseline and at the end of the intervention, individual hair samples (control: n = 59, intervention: n = 64) were analyzed for zinc and sulfur content by XRF. Data were analyzed using linear mixed effects models to contrast between trial groups the changes from baseline to end point and also to compare baseline and end point values within each trial group. Increases from baseline to endpoint in both sulfur and zinc were significantly greater in the intervention group compared to control (sulfur counts. CONTROL baseline = 119.87 ± 20.33 and endpoint = 121.58 ± 23.58/intervention: baseline = 122.67 ± 24.19 and endpoint = 131.60 ± 21.34); (Zinc counts. CONTROL baseline = 50.88 ± 14.33 and endpoint = 54.82 ± 14.61/intervention: baseline = 49.61 ± 10.77 and endpoint = 58.79 ± 12.20). For these parameters, there were also significant increases from baseline to endpoint in the intervention group but not in control. Furthermore, for Zn:S count ratio there were no differences in terms of the magnitude of the change from baseline to endpoint in the control group, although significant increases from baseline to endpoint were evident in the intervention group (Zn:S count ratio. CONTROL baseline = 0.42 ± 0.10 and endpoint = 0.45 ± 0.08/intervention: baseline = 0.41 ± 0.08 and endpoint = 0.45 ± 0.08). A modest increase in dietary zinc over 6 months resulted in a detectable increase in both sulfur and zinc counts in individual hairs measured using XRF. This offers a sensitive, non-invasive method to monitor changes within subjects in response to dietary zinc interventions.
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Affiliation(s)
| | | | - Dan Asael
- Department of Earth and Planetary Sciences, Yale University, New Haven, CT, United States
| | - Mukhtiar Zaman
- Pulmonology Department, Rehman Medical College, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | | | | | - Bryn D. Rankin
- Physics Department, Mount Allison University, Sackville, NB, Canada
| | | | | | | | | | - Jonathan K. Sinclair
- UCLan Research Centre for Global Development, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Nicola M. Lowe
- UCLan Research Centre for Global Development, University of Central Lancashire, Preston, Lancashire, United Kingdom
- *Correspondence: Nicola M. Lowe
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Abdu AO, De Groote H, Joy EJM, Kumssa DB, Broadley MR, Gashu D. Zinc agronomic biofortification of staple crops may be a cost-effective strategy to alleviate zinc deficiency in Ethiopia. Front Nutr 2022; 9:1037161. [PMID: 36438724 PMCID: PMC9686331 DOI: 10.3389/fnut.2022.1037161] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/25/2022] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Inadequate dietary zinc (Zn) supplies and Zn deficiency (ZnD) are prevalent in Ethiopia, where cereals are major dietary sources, yet low in bioavailable Zn. Zinc agronomic biofortification (ZAB) of staple crops through application of Zn fertilizers may contribute to alleviating ZnD. However, large-scale promotion and adoption of ZAB requires evidence of the feasibility and public health benefits. This paper aimed to quantify the potential cost-effectiveness of ZAB of staple crops for alleviating ZnD in Ethiopia. METHODS Current burden of ZnD among children in Ethiopia was quantified using a disability-adjusted life years (DALYs) framework. Evidence on baseline dietary Zn intake, cereal consumption, and fertilizer response ratio was compiled from existing literature and secondary data sources. Reduction in the burden of ZnD attributable to ZAB of three staple cereals (maize, teff, and wheat) via granular and foliar Zn fertilizer applications was calculated under optimistic and pessimistic scenarios. The associated costs for fertilizer, labor, and equipment were estimated in proportion to the cropping area and compared against DALYs saved and the national Gross Domestic Product capita-1. RESULTS An estimated 0.55 million DALYs are lost annually due to ZnD, mainly due to ZnD-related mortality (91%). The ZAB of staple cereals via granular Zn fertilizer could reduce the burden of ZnD by 29 and 38% under pessimistic and optimistic scenarios, respectively; the respective values for ZAB via foliar application were 32 and 40%. The ZAB of staple cereals via granular fertilizer costs US$502 and US$505 to avert each DALY lost under optimistic and pessimistic scenarios, respectively; the respective values for ZAB via foliar application were US$226 and US$ 496. Foliar Zn application in combination with existing pesticide use could reduce costs to US$260-353 for each DALY saved. Overall, ZAB of teff and wheat were found to be more cost-effective in addressing ZnD compared to maize, which is less responsive to Zn fertilizer. CONCLUSION ZAB of staple crops via granular or foliar applications could be a cost-effective strategy to address ZnD, which can be integrated with the existing fertilizer scheme and pesticide use to minimize the associated costs.
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Affiliation(s)
- Abdu Oumer Abdu
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hugo De Groote
- Sustainable Agrifood Systems Program, International Maize and Wheat Improvement Center (CIMMYT), Nairobi, Kenya
| | - Edward J M Joy
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Rothamsted Research, West Common, Harpenden, United Kingdom
| | - Diriba B Kumssa
- School of Biosciences, University of Nottingham, Loughborough, United Kingdom
| | - Martin R Broadley
- Rothamsted Research, West Common, Harpenden, United Kingdom
- School of Biosciences, University of Nottingham, Loughborough, United Kingdom
| | - Dawd Gashu
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
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